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Better glycemic control could slow kidney complications in patients with type 1 diabetes
By improving their blood glucose control over the long term, patients with type 1 diabetes and kidney complications can delay the progression to end stage renal disease, according to research published in the Journal of the American Society of Nephrology.
An observational study at Joslin Diabetes Center in Boston, conducted by Jan Skupien, MD, of the center and Brigham and Women Hospital, Harvard Medical School, and colleagues, tracked kidney impairment among patients for nearly 2 decades, starting in 1991.
The investigators looked at 349 adults with type 1 diabetes enrolled in the Joslin Proteinuria Cohort who were already in stages 1 to 3 of chronic kidney disease. They followed the patients, who had developed proteinuria between 1990 and 2004, until 2011 to determine end stage renal disease (ESRD) onset and unrelated deaths; data from 279 patients with at least 3 years of follow-up was analyzed to evaluate glycemic control since enrollment.
The researchers compared mean HbA1c levels in the 5 years before study enrollment with levels in the first half of follow-up, also approximately 5 years — 9.3% vs. 8.7%, respectively.
At 15 years, overall risk for ESRD was significantly lower for patients who reduced their HbA1c compared with those whose had an increase or remained at the same level (29% vs. 42%; P<.001). The difference between groups was not apparent at 5 years, but became clear at 10 and 15.
Using multivariate Cox regression analysis, the researchers determined ESRD risk corresponding to a 1-percentage point improvement in HbA1c after baseline (HR=0.76; 95% CI, 0.63-0.91).
“The results of this study suggest that long-term sustained improvement in HbA1c decelerates eGFR and delays the onset of ESRD in patients with type 1 diabetes and proteinuria,” the researchers wrote.
The findings go against earlier, but smaller, investigations that suggested better glycemic control did not slow kidney complications.
Optimal HbA1c levels are not even required to substantially delay adverse outcomes in patients with proteinuria, Andrzej S. Krolewski, MD, PhD, head of the Section on Genetics & Epidemiology at Joslin, said in a press release. “We are talking about improving HbA1c from 11% to 9%, or10% to 8%.”
Disclosures: This research was supported by a grant from NIH and from research and fellowship grants from the Juvenile Diabetes Research Foundation.